Doctor Name: | MARY R BENNETT |
NPI Number: | 1104148162 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CMT, NCTMB |
License Number: | MT20900282 |
Business Practice Address: | 2734 Washington Ave Bedford, IN - 474215314 |
Business Phone Number: | 8122765941 |
Business Fax Number: | 8122754654 |
Mailing Address: | 2734 Washington Ave, BEDFORD |
State: | IN |
Postal Code: | 474215314 |
Phone Number: | 8122765941 |
Fax Number: | 8122754654 |
NPI Enumeration Date: | 02/18/2010 |
NPI Last Update Date: | 02/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT20900282 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |